Provider Demographics
NPI: | 1033573142 |
---|---|
Name: | THE REGENERATION PROJECT LLC |
Entity Type: | Organization |
Organization Name: | THE REGENERATION PROJECT LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RODDRICK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STOKES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 410-254-6175 |
Mailing Address - Street 1: | 1 N CHARLES ST |
Mailing Address - Street 2: | 1400 |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21201-3740 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-254-6175 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1 N CHARLES ST |
Practice Address - Street 2: | 1400 |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21201-3740 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-254-6175 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-04-06 |
Last Update Date: | 2016-04-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 18565 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |